CMS Pub. 100-05, ch. 5, § 40.8.11

Payer

(Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22)

Rules concerning submitting data to CWF if the Medicare payment amount is zero are as

follows:

• If the MSP payment module determines that the Medicare payment

amount is zero, A/B MACs and DME MACs do NOT complete the

nonpayment code;

• The "Utilization Days" field of the CWF record contains the days the

MSP payment module determines to be charged to the beneficiary's utilization

record. If the Medicare payment amount is zero, this figure must also be zero;

• The "Cost Report Days" field of the CWF record contain zero days;

• The "Value Code" field in the value data portion of the CWF record

contains the appropriate value code to identify the primary payer. (See Pub. 100-

04, Medicare Claims Processing Manual, Chapter 25, §70 and 75, Field

Locators 39-41, for appropriate value codes.);

• The "Value Amount" field in the value data portion of the CWF record

contains the amount Medicare would have paid in the absence of the primary

payer's payment. (The A/B MAC (Part A) does NOT record this amount on the

PS&R.);

• The A/B MAC (Part A) does not record days or charges on the PS&R; and,

• The A/B MAC (Part A) submits the bill to CMS in

accordance with CWF documentation.

The CMS uses data reported in the blood deductible and inpatient deductible items to

update deductibles. (This data is not used for the PS&R.)